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Hi everybody and welcome to another episode of Airway First, the podcast from the Children's

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Airway First Foundation. I'm your host, Rebecca Basma. Our guest today is Dr. Steve Carcensen.

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He is an airway-centric dentist who has treated patients with sleep apnea and snoring in Bellevue,

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Washington since 1988. He's the consultant to the ADA for sleep-related breathing disorders.

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He's trained at UCLA's mini-residency in sleep and is a diplomat of the American Board of Dental

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Sleep Medicine. Dr. Carcensen lectures internationally, directs sleep education at Airway Technologies

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and the Panky Institute, and is a guest lecturer at Spear Education, University of the Pacific,

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and Louisiana State Dental Schools. He was a board member for the AADSM,

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Editor of Dental Sleep Practice Magazine, and co-authored a clinician's handbook of Dental Sleep

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Medicine. You can find out more about Dr. Carcensen at seattlesleepeducation.com and

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at stevecarcensendds.com. And now, I hope you enjoy my interview with Dr. Steve Carcensen.

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Thank you so much for joining us on the podcast. I really appreciate it.

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Oh, sure. It's a pleasure to talk to you anytime, Rebecca.

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Thank you. Thank you. All right. So before we dig in, let's talk about just so everybody kind of has

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a baseline of what we're discussing. What actually is dental sleep medicine?

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That's a great question, actually. And I got a little background for you because

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as part of Dental Sleep Practice Magazine, where I'm the Chief Dental Editor, I just interviewed

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dentists who started the American Academy of Dental Sleep Medicine. It was called the

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Sleep Disorders Dental Society back then, 30 years ago this year. Okay. So I was asking Dr.

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Rogers, I said, you know, tell me about the term dental sleep medicine. Kind of the same question

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you just asked me. And he said that he coined the term about 20 years ago to describe how dentists

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interact with physicians and how do we blend them together? Because we have dentistry and we have

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medicine in this specific field of sleep. And how it got started back then is the

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physicians were figuring out how to help people who were sleeping badly. And it turned out they

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were breathing badly when they were sleeping. And so they discovered the disease of obstructive

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sleep apnea came up with some treatments and dental medicine provided treatment for that.

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At the same time that CPAPs provided treatment for that. So dentists were involved from the

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beginning of treating bad breathing at night for adults. It's all adults. And so they said,

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well, how do we label ourselves? Because we're not just, you know, at the time they were thinking

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not just dentistry. So they decided to call dental sleep medicine. So it's really just trying to describe

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the intersection between what dentists can do with primarily many of their advancement devices in

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adults and what physicians can do for the medical side of the disease. Okay. So it's a,

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it's, now it's an imperfect time, but it's, it's what we think about these. We were talking about

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30 years ago. Yeah. So can dentists actually diagnose sleep apnea? Not currently. No, what

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disease of sleep apnea is a medically recognized problem. So the role that physicians have to

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diagnose is important because there's a lot of interactions with other medical problems that

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dentists aren't trained about at all. What dentists can diagnose is a mechanical problem with breathing.

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In other words, we can tell whether somebody snores, we can tell whether somebody's airways

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closing, but the medical situation of obstructive sleep apnea is a medical diagnosis. We need

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physicians for that. Okay. And typically a physician, you would, you would recommend somebody

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to a physician or tell them, you know, Hey, this is what I see. And you would

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communicate with that physician somehow. Yeah. The biggest problem we have in the world really is,

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and it's taught by United States and adults so far, we're going to talk about kids here a little bit.

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I know we are. Yeah. Oh, yeah. We've heard about adults for just a second because that kind of sets

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a stage. And for adults, what we have is that 25 years ago or so when I was learning about all

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this stuff, they told me that 15% of the adults that have sleep apnea have actually been diagnosed.

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Today in 2022, if you go to the best experts, they may grudgingly acknowledge that 20% of the

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people that should be diagnosed have actually been through a process. So we're not getting

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anywhere and getting adults diagnosed over these 25 years. So that's one of the problems we have

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is that we only have a few physicians doing the diagnosis. So what the interest can do is what

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we're, what is, we can make more people aware that they have a breathing problem and facilitate

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their diagnostic process. And that's changed a whole bunch in the last even couple of years.

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COVID has drawn a new set of rules up for diagnosis. Because the in-person visits have gone to be

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minimized. We learned of when we were forced to do telehealth, that in fact, telehealth works pretty

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good. That's something that's more consult, consultative like sleep medicine and able to be

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tested in remote facilities. In the early days, the only testing they had was in specialized

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rooms and hospitals. Nowadays, that's still done, but it's done less often because we have

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home ways of testing at home. So you can get a sleep lab level quality at home and then kind of a

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real life environment. Not quite accurate statement. Home, real life environment, those two true

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quality sleep lab quality, not quite there yet. But it's getting here because the technology is

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getting better, faster, cheaper. With a big company out of France, there's a lot of technology,

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they've really jumped on the board for these remote monitoring devices. And they have a

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pad in fact that goes underneath a mattress that measures many of the same biosignals,

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kind of a new term for us all biosignals. They measure the same biosignals that we get out of

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the quote, official unquote, home sleep apnea test. And because it's all in the cloud,

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they just released a study that had 68,000 patients over 11.6 million sleep nights.

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The biggest bunch of data that's ever been gathered about sleep. And they found out that 20%

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of the sleep tests nights were incorrect. So back to your question, sleep lab quality at home,

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not quite because we have devices that accurately measure the biosignals,

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but we have to think that one out of five of those nights of testing is probably inaccurate.

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And that means that if you go to your sleep physician, say you're screened by your dentist

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and oh great, great. You know what? That story is a problem. So I'll go and get tested.

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And I get hold of my physician, a sleep physician, and the physician says, great,

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I'll send you a monitor. You strap it on, we'll learn how you do. And you get one night with that.

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What if that's one of the five nights? What if that's your five? Yeah.

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Yeah. Now we have the worst possible way of a false negative because we have a patient who has

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complaints, I'm snoring, I'm not feeling well, a dentist who says, dude, you got to do something

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about this. The patient actually becomes one of the 20% and they go on and seek a diagnosis.

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But the test is faulty. And so the test says, no, patients, you don't have a diagnosis. You don't

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have a disease. Well, now what's the yes? The sleep physician doesn't have any place to go

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because their test says no. The patient still says, okay, dentist, you told me I was in trouble.

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Now they said I'm not in trouble. So what am I supposed to do about this?

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Right. So it's a conundrum that we haven't quite solved yet. But the solution is going to be

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the fact that we can do multiple nights testing now for low money and low trouble. And if that's

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the case, then we can accept that first night. Oh, that doesn't line up so much.

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That's not a way.

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All right. It all comes down to money on that.

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And insurances, are we at the point that insurances will pay for or supplement these tests at home?

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Sometimes what the common accepted protocol right now is that if the clinical symptoms don't line

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up with the home sleep tests, then that qualifies the patient to go into that in-lab,

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very detailed study. But that costs thousands of dollars for that study.

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And so the insurance companies, they don't pay for that. So what is going to happen, I think, is

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they'll, the insurance companies will say, okay, great, doctor, feel free to have the patient do

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multiple nights at home so we can eliminate that one in five event. But that data is all brand

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new in the insurance companies. They don't change quickly.

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Right.

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Most of the sleep physicians I work with here in the Seattle area do one night tests.

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And if they don't qualify that way, if it doesn't line up clinically, it doesn't make sense to them

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that into the sleep lab, the patient isn't right it. But patients don't like those sleep tests.

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Right.

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And so it's just a problem. Another one physician on here does three nights all the time

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because he's aware of the details of this stuff. But I'm not sure how that's paid for

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because insurance companies don't tend to like to pay extra.

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Right. Right. Understood. So when it comes to adults, I know that traditionally, and we've had

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another guest on that's spoken about this, the CPAP, this is the door to go, the outside, I don't

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know what you call it, the equipment. But I heard you speak about the TAP system. So what exactly

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is the TAP system? Is that an alternative? Sure. Well, we got to back up again.

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Okay.

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So when they discovered the problem of obstructive sleep apnea, what Dr. John Remers came up with

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is, wow, these people's airway collapses behind their tongue. And so the treatment that he and Dr.

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Colin Sullivan came up with is, well, if we put a little bit of air pressure

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into the upper airway through the nose, then we can splint that airway open so it doesn't

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collapse, we'll be briefed. Okay, great. That became CPAP. And the measurement that they used

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to, as the kind of the dragon to fight in sleep apnea is called the apnea hypopnea index. They

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measure how many times does somebody stop breathing, how many times does their breathing get restricted,

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and they divide by a time factor, and they have an index. So that's our score system.

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Okay.

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If our goal is to fix the score down to normal, CPAP is the very best thing possible,

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because it fixes the AHI, the apnea hypopnea index, the score. It fixes that.

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Okay.

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But the problem is, is it comes with a bunch of baggage. And so the patients don't like it.

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That, you know, of course some patients do like it, but only about 30% of people,

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according to most studies, actually use the CPAP the way they're supposed to.

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So we have a treatment that does, it's very effective when it's being used.

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When it's only being used 30% of the time, correct. But it's still labeled gold standard

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treatment. And I think that label has to go away because there's, it's not possible to call

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something gold standard. It's only used 30% of the time.

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Thanks.

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And study after study nowadays is showing that the overall health impact of CPAP is less of

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because of this lack of use.

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Okay.

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So back to the early 80s, and already by the early 80s, the dentists were saying, well,

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wait a minute, CPAP isn't being used very well. People don't like that back then,

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even bigger and noisier, more cumbersome devices.

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So, so very smart dentists, Tom Mead and Albuquerque, Keith Thornton and Dallas, several,

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Alan Lowe up in, in Victoria and Coover BC and others were coming up with these ways of holding

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the airway open, just thinking about the 3D anatomy.

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Isn't we have a movable lower jaw or mandible and jut forward.

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And soft tissues like the base of the tongue are attached to that movable bone.

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So if we move the bone forward, maybe we get the soft tissues out of the way and do the

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same thing the CPAP was trying to do. So oral appliances were developed to do that very thing.

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And that Thornton adjustable positioner named after Keith Thornton, who invented it, called the tap,

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was one of the earliest devices. And so the tap system, I think is great because of a couple

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things I'll tell you about a second, but that is really just part of what is now 150 or so

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FDA cleared devices, all aimed to do the same thing, which is to keep the airway from collapsing

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while people sleep. 150 approved devices. So we're in that range. I don't know the exact

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number of this. It's close to that number. Had no idea. Because the thing is holding the jaw

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forward is the thing, but there's a lot of invention associated with the way to do that.

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And that's the big contrast with CPAP. Because although positive air pressure,

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PAP, part of those things, it can be applied in several different ways because there's

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CPAP, there's BIPAP, there's adaptive PAP, there's all these kinds of things. It's a whole positive

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air pressure. But oral appliances have all these different designs because they really were developed

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in the hands of creative dentist types. And so or some engineers, but mostly dentists. And so what

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they said, well, we could try this little wing or that screw or this kind of mechanism or this hook

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or whatever the case may be, that it's all aimed to hold the jaw forward in different and more,

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you know, in their view, the most comfortable, the most effective, the easiest to the patients to

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adhere to. And the key to it right there is, is it effective for the problem? Does it fix the

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AHI score, but also other things? And will the patients accept it? Whereas seat that has to be

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accepted by what, how does the mask fit? How quiet can we make the pump? You know, those kind of

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things. The oral appliances being customized by dentists who completely understand the anatomy

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and the function of the, that part of the body, the oral cavity and the head and neck, they can say,

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well, this wing would be more comfortable. This design would address this muscle issue. You know,

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this way we can give people to adjust it will be something that they'll actually use. So they

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put the tap stay in. Does the, does the tap stay in? Is it an oral appliance you wear all the time

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or is it just when you sleep? Oh, you only need to support the airway during sleep.

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Okay. Yeah. Well, we're all awake. The muscles of our airway resist negative pressures of breathing.

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When you breathe in, you pull the negative pressure into your chest to fill your lungs.

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Well, so we have muscle function to keep that from collapsing in daytime.

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Nighttime is when that muscle function goes away and taps and others keep that from collapsing.

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So the tap has a benefit because it holds the jaw forward with a little connector in the front.

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So it's free moving side to side, but not forward and back. So the top can't fall backwards while

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somebody sleeps. And then the other thing that tap has going forward that I really like is that

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it comes with a removable silicone mouth shield. So it goes under your lips and makes

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your nose breather. The nose breathing is the key to health. Yes, it is. Yeah. And we're going to

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track that's going to transition us into talking about kids because Dr. Thornton said, wait a minute,

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we emphasize nose breathing for kids all the time. So what about these adults and these appliances?

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What, how can we make sure that happens? They came up with a silicone cover into tap system

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that makes you an obligate nose breather. And that turns out to have so many health benefits.

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Now we're going for far more than just fixing the score of the AHI. We're actually helping improve

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physiology by making sure people breathe through their nose. Nice. Nice. So yeah, that does.

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That transitions right into where we're going to go, which is talking about kids. Hey, look at that.

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Kids, kids and kids health. Because we know that as adults, what we've heard, right? We've all heard

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what not sleeping can do to you and all the health impacts. But we really haven't,

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but until recently talked about reading and sleep and the way they correlate with children

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and their health. As they're growing, but then that's what's going to manifest and cause all

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these health implications as they get older. So when we're talking about kids and we're talking

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about, let's just start with sleep specifically. Why is that so important for kids?

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Well, you know what? You know the really interesting part about that, Rebecca? They don't really know.

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We don't know why. We don't know the function of sleep in great detail. There's been big volumes

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written. One of the best is by Matthew Park, Matthew Walker. Matthew Walker, yeah. Why are we sleeping?

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Why are we sleeping? Yes. But even that's about adults. And so the key about kids is so difficult

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to test. Sleep medicine came around because of adult problems. Adults having troubles in hospitals,

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adults being observed by physicians. So the rules are written for measuring adults. The

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tools were developed to measure adults. And somewhere along the way, of course, pediatricians

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and physicians said, look, there's little kids out there that don't seem to be sleeping well either.

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And there seems behavioral troubles. And in my practice, like for example, you know, I have 55

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year olds in my practice that have chronic disease, chronic inflammatory related diseases

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like cardiovascular disease and diabetes. Where did that come from? It came from decades of

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struggling to breathe at night time. So if I was 55 year old in my practice, at one point,

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they were 5.5 year old. Right. And so could there be a root cause of some of these adult problems

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in children? Well, it makes logical sense. Then you kind of try to go to medicine and science

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and think, how are we going to figure this out? Right. And the only good way to figure it out,

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I mean, oh, not good. The only incontrovertible way of doing this is to gather up a bunch of

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5.5 year olds, get a figure, figure out whether they breathe badly at night time,

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put half of them into some kind of treatment to fix that, and leave the other half untreated.

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And then wait until they're 55 and see what happens. Well, there's many things wrong with that.

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You'll never be able to do that study because once you diagnose a child, especially with a disease,

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they don't have the, they can't be the 55 year old says, I'm not going to treat this.

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They, you know, you can't ethically withhold treatment from some of them. So you have to

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randomize control trials. All we can do is we can look at populations of kids who were treated

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and populations of kids whose families decided that treatment wasn't going to be possible for them

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for whatever reason that is. And then look and see. So that makes matching populations a little

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difficult. Some of it's been done. Karen Bynik has done a big study in a town in England that's now

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about 20 years old. So we have some pretty good data about what goes on, but what we don't have to

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rely upon is the fact that we can consider a child who doesn't breathe well to be less healthy than

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a child who does breathe well. That makes sense. We don't make science to tell us more than that.

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So let's figure out why they don't breathe well. And if they don't breathe well from bad habits,

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like for some reason they just developed a mouth breathing habit, maybe we can fix that.

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You're listening to Airway First with today's guest, Dr. Steve Carcinton.

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You can find out more about the Children's Airway First Foundation and our mission to

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ensure that every child has access to screening, evaluation, and treatment of all children's airway

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disorders before the age of six on our website at childrensairwayfirst.org. You can also find a

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ton of great resources for parents on our website, including videos, blogs, recommended books,

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comprehensive medical research, a parent's forum, and so much more. As a reminder,

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this podcast and the opinions expressed here are not a medical diagnosis. If you suspect your child

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might have an airway issue, contact your pediatric airway dentist or pediatrician.

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And now back to our interview with Dr. Stephen Carson.

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Right. And we try and measure what's going wrong. All we're really doing there, Rebecca,

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is we're measuring a symptom. Because if they don't sleep well, it's because they don't breathe well.

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Right. So why would we treat the sleep problem? Let's treat the breathing problem. And so why

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wouldn't they breathe well? We have to think backwards on that. And now we run into a big problem.

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Because if they don't breathe well, it could be a habit, but it could also be an underdevelopment

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of the, well, Dr. Kevin Boyd, somebody else you're going to have on your program, no doubt,

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because he's an expert. Oh, yes. He's also on our board. Yeah. All those things. Kevin,

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we're so grateful in the world to have a Kevin Boyd. Yes. So he came up with a term called the

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craniofacial respiratory complex. So you have RC. Then I told Kevin, I said, I love that concept.

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I love the thought of a craniofacial respiratory complex as the thing that we have to think about.

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I don't love the term because it's hard to say. It's very hard to say.

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But, you know, can you briefly explain to people that don't know what that is?

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Of course. Yeah. So I'll explain the term craniofacial respiratory complex.

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So we have the cranium, the skull, that's where your brain is, and that's the base of things.

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That's what things grow from. Right. The facial portion is what we see from the

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front. It's the, your cheekbones, it's your, the support of your cheek and the,

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how far forward your nose is, how far forward your teeth are, where does your chin go?

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And how wide is this? So it's the three dimensional structure that's the face. Okay.

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Well, what's, what's inside the face, of course, are things that dentists pay attention to,

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like teeth and by instance, smiles, but also those same bones that support what we see as the face

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and the nose and the teeth supports the airway. So as, and we dentists and ENT doctors as well,

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but mostly dentists are the specialty in medicine for how that face develops. We're the only part of

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medicine that can go into a 5.5 year old, recognize that that bone is not growing to support the

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airway properly and do something about it. Now we're not talking about syndromeing kids,

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kids that have a genetic problem where they're, you know, they just have a growth issue that's

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by their genes. We're talking about normal kids, millions of millions of normal kids.

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And then I don't mean normal, you know, anyway, so, so regular kids, regular kids, there's a bit

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of one. All right. So, so, so if you get in a regular kid in a practice, in a dental practice,

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where the dentist is looking at the structure of things, cranium, we're not going to do much about

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cranium. We can do, we can do a lot about facial. And we can do a lot about respiratory, the way

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that the child is breathing. Because we can measure that and we can look at it and we can,

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we can ask about that and we can notice things. No, do things such as like the, the jaw being too

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far back or there's not enough room or what kind of things do you notice? Yeah, we can notice the

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first office, are they breathing through their nose or their mouth? If, if the child is sitting in

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your dental chair or sitting on your reception room or in your family and they're breathing through

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their mouth, that's wrong. That's a sign. Yep. Because when the mouth is open and therefore

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breathing through the mouth, there's several bad things that happen. Today I will grab things.

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One of them is the tongue can't be in the root of the mouth because if it is, you can't breathe

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through your mouth. Right. At least your tongue is in the floor of your mouth. Okay. Well, if your

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mouth is open, your chin down, mouth open, your cheeks now put a little bit of pressure on the width

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of the upper jaw, the menacella. Yeah, because the tongue is in the floor of the mouth, it can't

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resist that pressure on the palate. So therefore the maxilla is pinched narrow. And when the maxilla

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is pinched narrow, the palate is pushed upwards. It's pushed upwards into the nose.

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So now we have less room in the nose. And we're shook. I know everybody's going to be doing this

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at home. Where should your tongue be, he actually. Your tongue should be in your palate all the time.

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Now when I'm talking, my tongue should rest against my palate. And not just the tip of my

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tongue up there and behind my front teeth, but my whole body of my tongue should rest against

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the whole body of my palate. And in a 5.5 year old, when that happens, then that little bit of

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pressure from the tongue resists the pressure from the cheeks and the maxilla grows wider.

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The palate looks like the top of the tongue, top of the tongue is flat, big, broad space.

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The palate should look like that. It shouldn't be a narrow little canyon.

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And because when it is a narrow canyon, it's going upwards and upwards into the nose and it

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takes the middle of the nose, the septum bends it over one side. So we end up in a dv.

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It's not cherry. And then if you can't breathe well through that smaller space,

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the low pressure there makes the soft tissues of the nose, the turbinates and other things that are

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involved in the nose. It makes them bigger, which means they even harder to breathe through your

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nose. So it's a complex. So the diagnosis isn't that these kids can't sleep well. The diagnosis

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is they're breathing badly through a small space. And we dentists can do that. We don't need a sleep

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study to tell if this child is not breathing. We don't need a sleep study to know whether the tongue

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positioning is or whether the jaw structure is growing too narrow or back too far. So we

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diagnose what we can diagnose, which is problems in this cranial facial respiratory complex.

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You know, the other cool part about this is we dentists can do something about the growth and

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development of the bones. Well, we mostly dentists and hygienists currently aren't trained in how to

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deal and do anything about the tongue position or how it's unfunctions or whether the swallow is

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correct. So we have our myofunctional therapy colleagues and our speech and language pathology

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colleagues to help us with training these little ones to be to function properly into this in this

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complex. The dentist can do something about and neither one of those strategies are available

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to sleep positions. Okay. Yeah. And you mentioned something that I mean, I understand it now from

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working with the Children's Airway Foundation, but y'all aren't trained to look at airways and to

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function, I mean, to focus on airways. Yeah. That to me is just mind boggling. I well, we're trained.

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We're well, currently we're back and we're not trained enough to focus on airways. We're trained

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to focus on the part of the body that controls the airway. But like like orthodox, for example,

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our orthodox colleagues are trained currently to see kids in now what Kevin Boyd calls geriatric ages,

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you know, like seven and nine, to and see what they're trained to see, which is a beautiful smile,

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a bite that looks good, the coordinates with the function of the jaw joints. Those are three great

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outcomes for an orthodontic process. Right. Whatever age it is, goodbye, nice smile, coordinated

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with the job. Sure. What we have to do though is we have to add in this airway focus. And the

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instruction in that is at a hawk at this point, because it's not part of hardly any dental schools,

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there's a little bit of work on a sundown school, but not enough. Okay. Part of medicine at all.

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Right. And so groups like Children's Air Enforced Foundation, and American Academy of Physical

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Medicine and Dentistry, AAPMD, ASAP, ASAP is a group of dentists who have developed a children's

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focused education program. I'm very proud of the American Dental Association for caring on the

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children's airway initiatives that we started with Dr. Boy and I and others started in 2018.

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So we have a growing amount of focus in education of dentists after middle school

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to pay attention to this from an airway perspective. You know, as a cranial facial

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respiratory complex, not just a good group of teeth, you know. Right. Right. And I'll have links

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to everything that you just mentioned in our podcast. So, you know, people can go check all of

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that out, which is awesome. One of the things that Dr. Boyd has mentioned, and I know you and I

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have talked about this before, as a mom, you know, the first time I heard him say this,

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I about fell out of my chair and thought, I'm a horrible parent, because he talks about,

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you know, these kids that are 11, 12, 13, where we're taking out teeth and we're putting on

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retractive braces. Yeah. Which, you know, I get it. I understand that. But now knowing what these

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signs and symptoms are of airway disorders, you know, that's the part as a mom that just sent

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me tailspinning going, oh, wow, I missed it on one of my kids. Oh my gosh. So parents that are

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at this crossroads, you know, that are being told, this is where we are. This is what you need.

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What are some things they can look for to ensure this is the right solution for their child? Because

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sometimes it is. But then what are the repercussions if they haven't undiagnosed airway?

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Well, one thing, one message we liked for all parents, families, all inclusive, let's just call it

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families. Okay. Yeah. Because there's families of all kinds of descriptions, right? Absolutely. So,

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so that what families should look at is how early in life can we detect any signs of problems?

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And one of the things that's really common is let's call it a five year old, five and a half,

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six, seven year old. If the front teeth have a beautiful smile, they're all touching like we

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look for an adult teeth, there's no gaps between the teeth. That's a very scary smile.

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Because what it tells us is that the bone structure isn't big enough yet. So when a child gets to be

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teenager years middle school, and they go to the orthodox and the orthodox says, oh,

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we don't have enough room for all of these teeth, we're going to have to pull out teeth and pull

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some things back together so we can give you this beautiful smile. So dentists are paying

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attention to it anyway, they think, oh, that's horrible. We should never take out teeth. You

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know, the extraction is the is the evil part. Well, I agree that extraction is the bad thing to do,

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but the problem isn't the teeth. The problems in the cranial facial respiratory problems.

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In the structure, in the airway support, right. But that way you have to look earlier in life.

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Okay, what are we doing? What's the message? The message is as early in life as possible,

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get a pediatric dentist or a dentist, a family dentist who knows about these things,

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to give an assessment for breathing in airway. And some orthodox, more and more orthodontist

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are understanding this expansion of their oversight. And they're paying attention to

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airway as well. That's what a calf is going to be. You know, that's the message out there,

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isn't it? Yes, that is. More of these health professionals paying attention to these little

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kids early in life. And then we can intervene when we can still grow the bone very easily.

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Yes. Because when Kevin sees a little kid who at five or four or three, that has a developing

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problem, they can put in a little tiny springy thing. And that bone responds to that. They can

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have the kid train on how to work with their tongue when they swallow and the bone responds to that.

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And so now when they're in middle school, the orthodontist looks in there and goes,

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oh, the teeth are kind of twisted a right a bit. Let's line them up right so we have a beautiful

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smile. But we don't have to worry about taking out teeth because there's plenty of bone there to

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hold all those roots. That's the goal we have. So when they're in middle school, they get the

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aesthetic alignment and the bite coordination, all the good things, but they don't have to worry

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about the size of the space. Right. Because that would have already been taken care of.

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That's extremely good. And what age, just because I want to hear you say it,

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because I was surprised about this. Again, as what age should or, well, I'm going to use the word

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should. Should you start taking a child to the dentist? Well, before age one. Yeah. I think

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that blows my mind. Yeah. Well, because it blows my mind too. I don't treat, as you know, I don't

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treat little kids. Right. I've never treated little kids. My dental practice was an adult

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dental practice. I'm super passionate about treating little kids in other people's offices

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because because they can't. And so important. So the media and dentists have all the behavioral

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training to start a child before age one on things that could be done age appropriate for that. Now,

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we're not going to put any little experience standards in a one year old. That's not going to

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work. Right. But what we can pay attention to is, are they breathing through the mouth? Is there an

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allergy problem? Is there even a tongue position? Sharon Moore, another future guest of yours.

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She talked last night about a child that she's seeing this a year and nine months. And so,

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before age two there, and this child has special needs, but all the things that Sharon was talking

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about, she could do. We, on the listening to her talk, were understanding she could do that on

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non-special needs children even before age one. Because there's amazing things that parents can do,

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in this case mostly moms, but can do for their 12 months, their 10 months old, to get them on the

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right track. Right. Such as what are just a couple of them? Yeah. Here's an easy one. If a mom of a

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newborn or a few months old notices mouth breathing, there's cultures with it. The standard is just

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the mouth, the mom reaches over, just holds her lips again. You don't have to do anything fancy,

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just hold lips together. Start a good habit of nose breathing. Of course, there's a whole bunch

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of things that can be learned about breastfeeding and tongue position of that and how to swallow.

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Is there a tissue that has to be removed? And several things about that that are all detailed,

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but you'll have future programs here. Because even at nursing time, breastfeeding time,

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first six months, eight and a half, and all at last, that starts the whole process of muscle

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training and bone development of the cranial ischolesteroid complex. Right. When a pediatric

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dentist gets involved before age one, when a family dentist gets involved, maybe at three

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or four or five, then we can start to recognize these troubles as early in life as possible

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and intervene as early in life as possible. Right. When they're still valuable and we can make a

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dentist. Because the bone is all plastic during those years. It can be pushed around.

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And if we recognize deficiency and growth, well, isn't it better to aim that growth at the right

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target? Yeah, absolutely. Absolutely. Because we'll do it later on in teenage years and adult years.

386
00:40:12,120 --> 00:40:21,480
I can really talk quality orthodontist Dr. Bacow in my town. I'm not going to do surgical procedures

387
00:40:21,480 --> 00:40:28,200
and move the bones around in 60-year-olds, but isn't it better at six? Right. Agreed. Agreed.

388
00:40:28,200 --> 00:40:37,480
And I know we touched on this briefly, but as far as your concept and your ideal, how should,

389
00:40:37,480 --> 00:40:44,200
going forward, in the best scenario, airway-centric dentists and pediatricians, how should they be

390
00:40:44,200 --> 00:40:50,680
collaborating and working together? Sure. So a child goes to a, typically goes to a pediatrician

391
00:40:50,680 --> 00:40:57,480
for some well-child visits, but oftentimes they're in there because of a complaint. You know, a cold,

392
00:40:57,480 --> 00:41:03,080
allergies, you know, they're not doing well. Well, if a child just isn't doing well,

393
00:41:04,360 --> 00:41:09,880
what would be the reason for that? And so the pediatricians' eyes are opened for seeing

394
00:41:09,880 --> 00:41:18,200
mouth breathing, for seeing, you know, a bad habits that way. That's how it doesn't seem to fit,

395
00:41:18,200 --> 00:41:24,600
quote, in the mouth. Those are the things that can be addressed early in life. But the pediatrician

396
00:41:24,600 --> 00:41:29,640
doesn't have to know how to do that. That's, they're not trained in this either. So they sit into the

397
00:41:29,640 --> 00:41:36,040
right pediatric dentist who now is, and the pediatricist says, okay, on this team, I'm going

398
00:41:36,040 --> 00:41:41,960
to need some habits, have it correcting. My dental assistant can help you with that. I have a speech

399
00:41:41,960 --> 00:41:46,520
and language pathologist with training and myofunctional therapy that can help you with that.

400
00:41:46,520 --> 00:41:52,440
I have dental hygiens for training and myofunctional therapy that can help you with that. And by the way,

401
00:41:52,440 --> 00:41:57,800
this jaw structure is too narrow here and sent back too far. And so for your child,

402
00:41:58,920 --> 00:42:05,960
parent, let's think about doing this little extender or this habit corrected. There's

403
00:42:05,960 --> 00:42:12,280
out of the shelf habit correctors that these kids can use where they just bite on this thing

404
00:42:12,280 --> 00:42:18,520
and it helps train the muscles. They helps to shape the bone, helps to train the tongue.

405
00:42:18,520 --> 00:42:24,440
All of these come with exercises. So, um, there's some real popular ones are healthy start and

406
00:42:25,240 --> 00:42:32,360
mild brace, uh, u control. There's several of these kinds of things out there that can let every

407
00:42:33,000 --> 00:42:37,240
dentist who gets trained on this by some of the organizations we talked about earlier

408
00:42:37,240 --> 00:42:45,480
can, uh, use some of these protocols to give families an easy solution. You know,

409
00:42:45,480 --> 00:42:51,560
it's not difficult for a child to accept that they have to, you know, chew on this little thing for

410
00:42:51,560 --> 00:42:56,920
an hour a day while they're playing. Cause if you make that a routine, the kid goes,

411
00:42:56,920 --> 00:43:01,320
no, I can do that. Yeah, they just do it. Yeah. We watch the videos, they play the games,

412
00:43:01,320 --> 00:43:06,840
they do all the cool things that are made for kids. And sure enough, they get themselves out of

413
00:43:06,840 --> 00:43:12,600
trouble. And they go to the pediatrician for the next one and the pediatrician says, what happened

414
00:43:12,600 --> 00:43:19,240
to your child? They used to be listless. Now they're full of energy or even better, they used to be

415
00:43:19,240 --> 00:43:25,080
uncontrollable full of energy and now there's a thermal. Right. Which is something that, that I,

416
00:43:25,080 --> 00:43:31,080
I think is interesting that, um, hypoxic brain injury. So you'll see kids with lowering IQs,

417
00:43:31,080 --> 00:43:36,360
ADHD kids are getting labeled with that. And it turns out it's an airway issue. Right.

418
00:43:36,360 --> 00:43:43,240
Not always, but a lot of times it is. Yeah. Steven Sheldon, one of our Steven Sheldon,

419
00:43:43,240 --> 00:43:49,400
a physician in Chicago, he's a DO, uh, sleep specialist up in Chicago at Larry Children's.

420
00:43:50,680 --> 00:43:57,480
He's one of our, you know, global heroes in this. He actually says he doesn't think ADHD exists.

421
00:43:58,120 --> 00:44:02,280
He thinks it's a brain response to other problems. And the other problem that's the

422
00:44:02,280 --> 00:44:09,080
primary one is breathing issues. Breathing, which is amazing. Yeah. So I'm not sure I agree. I'm

423
00:44:09,080 --> 00:44:15,640
serving out a diagnostician for ADHD, but, um, but some kids have, uh, so too many kids have

424
00:44:15,640 --> 00:44:22,280
benefited from the medications to say it doesn't exist in my view. But I think the vast majority

425
00:44:22,280 --> 00:44:29,720
of those kids haven't been, uh, uh, I haven't been evaluated for breathing issues. Right. And so,

426
00:44:29,720 --> 00:44:34,760
so I think that no child should be put on a ADHD medication without being evaluated for

427
00:44:34,760 --> 00:44:39,800
breathing issues by a competent dentist or an orthodontist is trained in the craniofacial

428
00:44:39,800 --> 00:44:45,960
respiratory complex. Right. I would agree with that. Um, so you've mentioned a couple of

429
00:44:45,960 --> 00:44:50,360
organizations and I just want to give you a moment and opportunity to speak about those.

430
00:44:51,400 --> 00:44:57,880
Yeah. We've talked about the AAPMD and the ASAP. Um, and then I see behind you, you've got your

431
00:44:57,880 --> 00:45:05,000
your collaboration cures 2022. Yeah. So, uh, you know, share a little bit about that with people

432
00:45:05,000 --> 00:45:10,360
about these organizations and your involvement and what they do. Well, um, the American

433
00:45:10,360 --> 00:45:17,160
ville association, the group for dentists passed a policy statement for airway issues a few years

434
00:45:17,160 --> 00:45:25,160
ago, 2017. So that got the ADA on board. And as those of us that have started to expand our

435
00:45:25,160 --> 00:45:33,640
practices into more and more airway, we've also come together in subgroups and a APMD. Uh, and

436
00:45:33,640 --> 00:45:39,560
another, there's several of them, a gosh, American Academy of Oral Systemic Health and some others

437
00:45:39,560 --> 00:45:45,080
have realized that, wow, you know, restoration and breathing patterns, they are the fundamental.

438
00:45:45,080 --> 00:45:50,120
We're trying to help you get healthy across the board. We can't do that if they don't breathe well.

439
00:45:50,120 --> 00:45:55,640
Right. So, um, you know, being small groups of dentists that are passionate about a certain

440
00:45:55,640 --> 00:46:02,120
subject, we find each other and we then start to think, what can we learn from each other?

441
00:46:02,680 --> 00:46:07,160
And it turns out there's physicians and there's physical therapists and there's speech and language

442
00:46:07,160 --> 00:46:12,600
pathologists all on the same kind of thinking path playing. We're going to get it once a year

443
00:46:12,600 --> 00:46:18,200
and they call it collaboration cures because it's putting everybody together to try and find a way

444
00:46:18,200 --> 00:46:26,280
out of this health problem that we have. And in 2022, it's going to be in September in Phoenix.

445
00:46:27,800 --> 00:46:33,160
And it's filled with speech and language pathologists and physical therapists and physicians

446
00:46:33,160 --> 00:46:39,160
and dentists and functional medicine folks. And we're all coming together to learn from each other

447
00:46:39,720 --> 00:46:45,880
and to sit in a conference room and hear a great lecture to go through a workshop to

448
00:46:45,880 --> 00:46:51,320
have a mixer where we, you know, sit out with our DO colleagues or our PTs that we've never talked to

449
00:46:51,320 --> 00:46:57,080
before and say, what can you do to help me understand the creative facial respiratory complex even better?

450
00:46:57,800 --> 00:47:03,240
And what can I do to help you? I mean, it's just all of that. It's just a fantastic group. It's my

451
00:47:03,240 --> 00:47:08,920
favorite event of the year is to go to collaboration college, a graduation cures.

452
00:47:08,920 --> 00:47:15,080
And I said it and I believe in that where did you meet? No, that's not where you met Candy.

453
00:47:16,760 --> 00:47:23,880
No, I met her earlier in the year. Different meeting in my therapy group. Yeah. Yeah, that was awesome.

454
00:47:24,440 --> 00:47:34,120
But you know, it's just, and I'm going to any of these is empowering because when you go to,

455
00:47:34,120 --> 00:47:39,560
you know, when dentists can speak from a dentist sample, we go to a dental conference.

456
00:47:40,120 --> 00:47:46,360
There's so much going on. There's lectures about vast numbers of subjects. There's a giant

457
00:47:46,360 --> 00:47:53,160
exhibit and finding a small group of people that are passionate about a something that just really

458
00:47:53,160 --> 00:47:59,480
excites you is more difficult. You go to a smaller meeting, like a malfunction meeting,

459
00:47:59,480 --> 00:48:05,320
and you're ready to a candy sparks. And you realize, wow, you know, look at the energy right here.

460
00:48:05,320 --> 00:48:10,520
There's that's attractive. So I want to find out more about that. And so I sit down with a candy

461
00:48:10,520 --> 00:48:15,160
spark. So I sit down with a Brad Guilden, a physical therapist. I sit down with a Sharon Moore, the SLP,

462
00:48:15,720 --> 00:48:22,600
and I learned what drives that. And they hear what drives me. Right. And we all work together.

463
00:48:22,600 --> 00:48:28,680
And it's really, it's really fun and energized again, changing. And it's changing. Yeah, you

464
00:48:28,680 --> 00:48:33,080
do it a lot of conferences, and you go away and you don't do anything different because you don't

465
00:48:33,080 --> 00:48:40,520
learn much. Right. You go to a focus group like collaboration cures. And man, you come away from

466
00:48:40,520 --> 00:48:47,560
there and you can't not change what you do. Right. And it sparks this conversation and it pulls

467
00:48:47,560 --> 00:48:52,600
people together and it creates these little subgroups become bigger groups and we're becoming a

468
00:48:52,600 --> 00:48:58,440
bigger and bigger movement, so to speak. I'm not sure what the right term is, but it's group.

469
00:48:58,440 --> 00:49:02,040
You know, we're all working, going towards the same goal, all driving together.

470
00:49:03,080 --> 00:49:08,760
And, you know, people gather together in small groups like this with this kind of passion.

471
00:49:08,760 --> 00:49:17,320
They don't have what we call it, agendas that require them to hold back information.

472
00:49:18,360 --> 00:49:25,240
Right. Their agenda is to spread it out. Right. And so the kind of people that I think of is like,

473
00:49:25,240 --> 00:49:31,560
you know, there's more pie than anybody can eat. And so the more we talk about the bigger the pie

474
00:49:31,560 --> 00:49:39,080
gets. And so there's no reason to hoard my piece of the pie. Right. I got plenty of pie. So let me

475
00:49:39,080 --> 00:49:44,200
tell you what I know. You tell me what you know. Right. And that makes us stronger too. Right.

476
00:49:44,200 --> 00:49:49,880
Right. What's that old quote? If I have an apple and you have an apple and we exchange apples,

477
00:49:49,880 --> 00:49:55,240
we each have an apple. But if I have an idea and you have an idea, now we exchange those and we each

478
00:49:55,240 --> 00:50:02,520
have two ideas. Right. So multiply that across 800 people with collaboration cures, you know,

479
00:50:02,520 --> 00:50:09,000
and look what happens. Right. It is definitely powerful. It is. Well, I thank you so much for

480
00:50:09,000 --> 00:50:15,080
being on our podcast and for all the work you're doing. Thank you so much. Well, it's such a lot

481
00:50:15,080 --> 00:50:20,520
of pleasure. You know, this is this is why you might be able to tell I'm energetic about this.

482
00:50:21,560 --> 00:50:27,560
I know. I appreciate that. Thank you. And thank you for you and the Children's Airway

483
00:50:27,560 --> 00:50:33,160
First Foundation. I think it's new. It's a year old. Congratulations. Thank you. And the work that

484
00:50:33,160 --> 00:50:40,440
you and Candy and Brad and the other advisory council are doing all my heroes on the advisory

485
00:50:40,440 --> 00:50:46,120
council. I mean, this is going to be something that's going to be a game changer for our profession.

486
00:50:46,120 --> 00:50:51,720
And that changes the world. It's absolutely what we're after.

487
00:50:54,040 --> 00:50:59,640
A huge thank you to today's guest, Dr. Steven Carsonson, for sharing his medical insight

488
00:50:59,640 --> 00:51:04,920
and to each of you for listening to today's episode. If you're new to our podcast, please

489
00:51:04,920 --> 00:51:10,760
don't forget to subscribe. And if you enjoyed today's episode, please remember to leave us a review

490
00:51:10,760 --> 00:51:16,360
or comment about what you enjoyed most. You can stay connected with the Children's Airway

491
00:51:16,360 --> 00:51:22,200
First Foundation by following us on Instagram, Facebook, Twitter and LinkedIn. If you'd like

492
00:51:22,200 --> 00:51:27,000
to be a guest on an upcoming episode, shoot us a note via the contacts page on our website,

493
00:51:27,000 --> 00:51:35,320
or send us an email directly at intro at childrensairwayfirst.org. And finally, thanks to all

494
00:51:35,320 --> 00:51:39,160
the parents and medical professionals out there that are working to help make the lives of kids

495
00:51:39,160 --> 00:52:03,240
around the globe just a little bit better. Take care, stay safe and happy breeding, everyone.